Telehealth pilots begin the move to business class

Written by Kate McDonald on 28 April 2017.

The memorable phrase first coined by Adelaide GP Tori Wade that telehealth in Australia has “more pilots than Qantas” got a nice little workout at the Australian Telehealth Conference (ATC2017) in Melbourne this week, but while it may be in vogue for a little bit longer, the consensus seems to be that we are beginning to see the move from itty bitty pilot projects to embedding telehealth as business as usual in the provision of healthcare.

That may not necessarily be true as yet in primary care, predominantly due to the funding model, but it is certainly beginning to be seen in secondary care, particularly for outpatients services for rural patients and but also in emergency care in regional areas where specialists are hard to come by. All states and territories are now taking telehealth seriously, even the small ones, and a lot of the thanks for that is due to a mixture of political enthusiasm for sexy tech but also the hard yards that a number of clinical groups in a number of states have done over the years.

In Victoria, which admits it is a bit behind on telehealth in comparison to Queensland and NSW, the Royal Children's Hospital has been a pioneer. At the ATC this week we also heard from another project that struck out on its own: the Victorian Stroke Telemedicine program, which has linked up 16 regional hospitals to 16 consultant neurologists who are available 24/7 for stroke diagnosis, one of whom has conducted a telehealth conference from the car park of the MCG.

The Florey Institute's Chris Bladin now hopes to roll this network out nationwide and even to New Zealand, where a colleague has returned after completing a fellowship and is eager to keep consulting from Christchurch. New Zealand is also making moves in telehealth – it has a national telehealth service for primary care that NZ Health Minister Jonathan Coleman is completely enamoured with, along with a number of services run by district health boards.

One of those we have covered quite a lot recently – the Virtual DHB at Waikato, now known as SmartHealth. Aussies may think that it is the South Island of New Zealand that has vast swathes of remote hobbitland where telehealth is needed, but Waikato in the North is actually the most rural of all DHBs and has areas of high socioeconomic deprivation. They are doing some great stuff in linking rural patients to specialists and to community nurses, including using smartphones to encourage kids with rheumatic fever to continue with their antibiotic regimen.

It seems that at the secondary care level at least, the plan is for business as usual, but it is in primary care where most healthcare takes place, and we are still struggling to embed telehealth there. (Although we don't seem to have the problems being experienced by some doctor-on-demand telehealth services in the US, which apparently has a flasher problem.) In our poll last week, we asked if readers supported the expansion of MBS items for telehealth, following the decision to provide Medicare funding for psychology sessions by videoconference. In something we've not seen before, every single respondent to the poll said yes. 100 per cent.

Comments

In my general practice I use remote monitoring of patients with insulin dependent diabetes, hypertension and found compliance, patient satisfaction and clinical outcomes enhanced. Although some of the senior patients had initial challenges using technology this was overcome with technical support over the phone and house calls. Interestingly, in stabilizing blood sugar levels the remote monitored graphs perhaps helped more than relaying on the traditional gold standard of measuring HbA1c. Currently, there is no Medicare rebate for remote monitoring in general practice, however I found that there is better clinical outcomes and both my patients and I enjoy the new dimension of therapeutic relationship. Max Mansoor